• Care Home
  • Care home

Archived: Marquis Court (Windsor House) Care Home

Overall: Requires improvement read more about inspection ratings

Littleworth Road, Hednesford, Cannock, Staffordshire, WS12 1HY (01543) 428429

Provided and run by:
Four Seasons Homes No.4 Limited

Important: This service is now registered at a different address - see new profile

All Inspections

16 May 2023

During an inspection looking at part of the service

About the service

Marquis Court (Windsor House) Care Home is a nursing home providing personal and nursing care to up to 52 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 34 people using the service (although 1 person was in hospital at the time of our visit). People would normally live in bedrooms spread across 3 floors; however, the lower-level floor was closed at the time of our inspection as the home was not full and to concentrate staff on the ground and upper floor.

People’s experience of using this service and what we found

Quality assurance systems in place were not always effective at identifying concerns or areas for improvement. The provider had failed to implement and sustain improvements. There had been numerous management changes in the home which may have impacted the provider’s ability to make improvements. There was mixed feedback from relatives about communication. Medicines were not always safely managed. This had been an ongoing concern in the home, so lessons had not always been learned when things had gone wrong. The home required redecoration and work was ongoing to achieve this. People had access to other health professionals, but improvements were needed to the systems in place to monitor this.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service had not always supported this practice. Action was taken in response to this following our feedback.

People were protected from harm as there were detailed care plans and risk assessments in place and staff knew people well. People were protected as infection control measures were in place. There were enough staff to respond to people’s needs; however, we did receive mixed feedback about the staffing levels. Staff were recruited safely. People were safeguarded from abuse. People were supported to have enough food and drinks of their choice and in line with their needs. People were supported by staff who had training and support to be effective in their role. Relatives and staff felt positive about the registered manager and felt they could report concerns, if needed. The registered manager understood their duty of candour. The home worked in partnership with other organisations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 April 2022) and there were continued breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement overall for the last 3 consecutive inspections. The well-led key question has been rated less than good for the last 7 consecutive inspections.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This inspection started with us looking at the Key Questions safe and well-led which contained those requirements.

When we inspected, we found there was also a concern with supporting people in line with the Mental Capacity Act 2005 so we widened the scope of the inspection to also include the effective key question.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see all of the sections of this report for the details of this. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marquis Court (Windsor House) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management, checking consent and quality assurance systems in place at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

27 January 2022

During an inspection looking at part of the service

About the service

Marquis Court (Windsor House) Care Home provides personal and nursing care for up to 52 people aged 65 and over across three separate floors, each of which has separate adapted facilities. At the time of the inspection 44 people were living at the home.

People’s experience of using this service and what we found

We found that Infection prevention and control measures in place were not protecting people from the risk of cross infection. Guidance from external infection prevention and control professionals was not being followed. Plans had not been put in place following a previous COVID-19 outbreak within the home.

People's risks were not always assessed and managed safely. Some of the processes in place to assess the quality and safety of the service were not always effective in identifying and addressing shortfalls. These issues were also identified at the time of the last inspection of the home and improvement had not been made to make the home safer.

The provider had systems in place to audit and monitor the quality of the service provided but these had, been ineffective and changes had not been actioned to improve the service. Risks had not always been identified or actions not taken to reduce risks after incidents. As a result, people had been placed at risk of harm. People who displayed behaviours that challenged, were not being consistently supported because there were no clear guidelines to help staff to keep people (and themselves) safe.

Care plans had not been updated to reflect people’s care and support needs following incidents where harm has occurred. The provider was in the process of adopting new processes across the service to improve the quality of care people received but these had not yet been embedded.

Overall there were sufficient numbers of staff to meet people's needs. However, the home used a high number of agency staff and when staffing had dropped below identified staffing levels it impacted upon the service people received.

Staff had received safeguarding training and were confident they could recognise and report abuse to keep people safe. Medicines management had improved and medicines were now being stored safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 15 July 2021).

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had also been made aware by the local authority of a COVID-19 outbreak within the home.

This report only covers our findings in relation to the Key Questions of Safe and Well-Led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will therefore continue to monitor the service and the warning notice issued in June 2021 will remain in place. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to set out what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

10 June 2021

During an inspection looking at part of the service

About the service

Marquis Court (Windsor House) Care Home provides personal and nursing care for 43 people at the time of the inspection. Marquis Court (Windsor House) Care Home can accommodate up to 52 people aged 65 and over across three separate floors, each of which has separate adapted facilities.

People’s experience of using this service and what we found

People’s risks were not always assessed and managed safely. Medicines were not always stored safely. Some of the processes in place to assess the quality and safety of the service were not always effective in identifying and addressing shortfalls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not always support this practice.

Staff had received safeguarding training and knew what actions to take to protect people from the risk of abuse. There were sufficient numbers of staff to meet people’s needs.

Infection and prevention control practices were in place and were effective in reducing the risk of the spread of infection.

The provider was in the process of adopting new ways of improving the practices across the service to improve the quality of care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good. Last report published (25 September 2019)

Why we inspected

We received concerns in relation to people not receiving adequate care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well- led sections of this full report. Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marquis Court (Windsor House) Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (governance) at this inspection.

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

10 September 2019

During a routine inspection

About the service

Marquis Court (Windsor House) Care Home is a nursing home providing personal and nursing care to 42 older adults. Care is provided on three floors. Some of the people are living with dementia. The service can support up to 52 people.

People’s experience of using this service and what we found

Some of the audits in place were not always effective in identifying inconsistences or areas where improvements were needed. Staff felt supported and listened to. Feedback was sought from people and relatives who used the service. There was a manager in place who understood their responsibility with regards to their registration.

The care people received was safe. Individual risk to people were considered and regularly reviewed. There were safeguarding procedures in place and these were followed. Medicines were managed in a safe way. There were enough staff available for people who were effectively deployed around the home. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice. Staff received training to ensure they had the skills to support people safely. People had access to healthcare professionals when needed. People enjoyed the meals provided and they were offered a choice. The environment was adapted to meet people’s needs.

People were supported in a kind and caring way by staff they were happy with. People were encouraged to remain independent, offered choices and their privacy and dignity was maintained.

People received care that was responsive to their needs. Staff knew people well and they received care based on their assessed needs. People’s preferences were taken in to account. People had the opportunity to participate in activities they enjoyed. Complaints were listened to, taken seriously and acted on.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement. (19 November 2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding’s. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

9 October 2018

During a routine inspection

This inspection took place on 9 and 10 October 2018 and was unannounced. At the last inspection completed on 4 May 2017 we rated the service Requires Improvement.

At this inspection we found improvements had been made, but more were needed and the service remains rated as Requires Improvement.

Marquis Court (Windsor House) is a Residential Care Home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Marquis Court (Windsor House) accommodates up to 52 people in one adapted building. At the time of the inspection there were 44 people using the service.

There was a manager in post at the time of our inspection, they had recently been appointed and had not yet completed their registration application, but plans were in place to do this. A Registered Manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were not always available to support people when they needed help. This meant people did not always receive support which was caring. Governance systems were not always effective in identifying concerns and driving improvements whilst some improvements had been made following our last inspection, more were needed.

Peoples medicines were administered as prescribed. Risks to people were assessed and planned for to keep people safe. Staff were safely recruited. People were protected from the risk of cross infection and safeguarded from abuse. The provider learned when things went wrong.

Staff were supported in their role and had access to an induction and training. People were supported to live in an environment which was suitable to meet their needs. People could choose their meals and were supported to eat and drink. People were supported to maintain their health and well-being.

People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

People had their privacy and dignity protected. People were supported to make choices and staff promoted people’s independence. Peoples communication needs were assessed and planned for.

Peoples preferences were understood by staff. People had access to a range of activities. People were clear about how to make a complaint and these were responded to. There was nobody receiving end of life care at the service so this was not considered during the inspection.

Notifications were submitted as required and the manager understood their responsibilities. People and their relatives were engaged in the service and felt able to approach the manager.

The location has previously been rated as Requires Improvement. At this inspection the provider had made improvements to those areas, but other areas were found to require improvement. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

4 May 2017

During a routine inspection

This inspection took place on 4 May 2017 and was unannounced.

At our last inspection on 22 November 2016, we rated the home as requires improvement overall and asked the provider to make improvements to ensure people were consistently protected from the risk of avoidable harm and to have the opportunity to take part in activities to promote their wellbeing and reduce social isolation. At this inspection, we found some improvements had been made but further action was still needed.

Marquis Court (Windsor House) is registered to provide nursing and personal care for up to 52 people. The accommodation is arranged in three units, Tivoli, Chase and Heath. At the time of our inspection, 34 people were living at the home, some of whom were living with dementia.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received their medicines as needed but improvements were still needed to ensure that medicines were consistently managed in a safe way and that effective checks and audits were in place to continually monitor this.

Risks to people’s health and wellbeing were assessed and managed and staff understood the actions they should take to minimise any identified risks. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing and staffing levels were kept under review to ensure they continued to meet people’s changing needs.

The registered manager and staff understood their responsibilities to support people to make their own decisions as much as possible. Where people lacked the capacity to make decisions for themselves, decisions were made in people’s best interests which followed legal guidance. Where people were being restricted of their liberty in their best interests, the registered manager had applied for the required legal approval.

People felt safe living at the home and staff understood their responsibilities to protect people from the risk of abuse. Staff received training so they had the skills and knowledge to provide the care people needed. People were encouraged to eat and drink enough to maintain a healthy diet and were able to access the support of other health professionals to maintain their day to day health needs. People were encouraged to keep in contact with family and friends and visitors were able to visit without restriction. Relatives felt involved in people’s care and were kept informed of any changes.

Staff had caring relationships with people and respected their privacy and dignity. Staff knew people well and people received personalised care. People’s care was regularly reviewed to ensure it continued to meet their needs. Improvements had been made and people were offered opportunities to take part in social activities that met their individual needs.

The provider and registered manager carried out checks to monitor and improve the quality of the service people received. People and their relatives were asked for their views on the service and were positive about the improvements being made by the provider. People felt able to raise concerns and complaints and were confident they would be responded to. Staff felt valued and supported by the provider and registered manager.

22 November 2016

During a routine inspection

This inspection took place on 22 November 2016 and was unannounced.

At our last inspection in September 2015, we rated the home as Requires Improvement overall and asked the provider to make improvements to ensure people received their care as planned. We received an action plan from the provider which said the improvements would be made by the end of December 2016. At this inspection, we found some improvements had been made but further action was still needed. We also found improvements were needed in the management and safe storage of people’s medicines and the checks carried out to monitor the quality and safety of the service.

Marquis Court (Windsor House) is registered to provide nursing and personal care for up to 52 people, some of whom were living with dementia. The accommodation is arranged in three units, Tivoli, Chase and Heath. On Heath unit, a number of people were living with advanced dementia. At the time of our inspection, 43 people were living at the home.

There was no registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was an acting manager who had started working at the service on 26 September 2016, who was in the process of registering with us.

At the last inspection, staff did not always follow risk management plans to ensure people received their care as planned. At this inspection we found action was still needed to ensure risk management plans consistently detailed the actions staff should take to minimise any identified risks associated with people’s care. We had recommended the provider reviewed the way staff were deployed to ensure people received timely support. At this inspection, we found there were sufficient, suitably recruited staff to meet people’s needs at all times.

Whilst we saw people received their medicines when needed, improvements were needed to ensure people’s medicines were accurately recorded and stored safely. The provider had systems in place to monitor the quality and safety of the service. The acting manager had identified the improvements needed but had not been able to implement these during the short time they had been working at the service.

Staff were trained to meet people’s needs but improvements were needed to ensure they were consistently supported in their role. People’s nutritional needs and preferences were met but the recording of people’s weights needed to improve to ensure prompt action could be taken when their needs changed. Improvements were still needed to ensure everyone living at the home had the opportunity to take part in activities and social events that met their individual needs and promoted their wellbeing.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns or complaints, they felt able to raise them with the staff and management team. Staff understood their responsibilities to protect people from the risk of abuse. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People’s care was reviewed and their relatives were kept informed of any changes and were encouraged to visit the home whenever they wished. People told us they accessed the support of other health professionals when needed.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, this was authorised in accordance with the legal requirements.

The acting manager had started to develop an open and transparent culture at the home which encouraged people, their relatives and the staff to give their views on how things could be improved.

9 and 10 September 2015

During a routine inspection

We inspected this service on 9 and 10 September 2015. This was an unannounced inspection. At the last inspection on 20 and 23 October 2014, we recommended the provider made improvements to ensure people’s emotional wellbeing was well promoted. We found some improvements had been made but further action was required to ensure people were consistently engaged and stimulated to promote their wellbeing.

The service was registered to provide accommodation and personal care for up to 52 people, most of whom were living with dementia. It provides nursing and personal care to people who live in three units, Tivoli, Chase and Heath. A number of people living on Chase and Heath units were living with advanced dementia and needed one to one support. At the time of our inspection, 49 people were living at the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise these identified risks. However, staff were not always following these to ensure people’s safety was maintained.

The provider had a recruitment process that ensured people were supported by staff whose suitability had been checked. Staff were supported and trained to meet people’s individual needs.  We have made a recommendation about how staff are allocated across the service.

People were supported to take part in activities but these were group based and did not always meet their individual preferences. Staff did not always engage with people living with dementia to ensure they received the stimulation they needed to promote their wellbeing.

Staff were kind and caring and people’s relatives told us they felt their relations were safe. Staff understood their responsibilities and the actions they should take to keep people safe from abuse.

People received their medicines in a safe way but improvements were needed to ensure an accurate record of the medicines held in stock at the home was maintained.

People were supported to maintain good health and accessed the services of other health professionals when they needed specialist support. People’s care plans were updated when their needs changed.

Staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have capacity to make decisions themselves, we saw that mental capacity assessments were in place and records showed that decisions had been made in their best interest. At the time of our inspection, 27 people were subject to a Deprivation of Liberty Safeguard.

People’s relatives knew the registered manager and felt able to raise concerns and complaints. The registered manager sought their opinions on the service and acted on feedback received. There were systems in place to assess, monitor and improve the quality and safety of care people received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

20 & 23 October 2014

During a routine inspection

This inspection took place on 20 and 23 October 2014 and was unannounced. Marquis Court (Windsor House) provides care for up to 52 older people living with mental ill health and/ or with dementia. It provides nursing and personal care to people who live in three units, Tivoli, Chase and Heath.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2014 we asked the provider to take action to make improvements to people’s care and welfare, nutrition and monitoring the quality of the service. This action had been taken.

People were kept safe at Marquis Court. Risks were identified and minimised to help keep people safe. Staff were aware of signs of abuse and knew how to act if they had any concerns about people’s welfare and safety.

People were supported to have their medicines as prescribed. Medicines were stored and administered safely.

Some people were unable to make certain decisions about their care. We saw that in these instances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People liked the food provided and had a choice of food and drink. People’s nutritional needs were assessed and monitored to make sure they received enough to eat and drink.

The staff worked closely with health care professionals to support people to have their health care needs met.

We observed and people told us that staff were caring and compassionate. People were treated with respect and their dignity and their privacy was promoted. Staff knew people’s individual preferences and these were acted upon.

We observed that people were provided with things to do but there were times when people were not engaged. We have made a recommendation about supporting people living with dementia.

The provider had an effective complaints procedure in place. People and relative told us that concerns were listened to and acted upon.

The provider took account of the views of people, their relatives and staff to improve the care people received.

People, relatives and staff told us that the service had improved since the manager had been appointed. People said she was visible, readily available and knew every person who used the service.

Systems were in place to check and monitor the care people received. Where shortfalls were identified these were acted upon.

24 April 2014

During a routine inspection

This was an unannounced inspection. As part of this inspection we looked at the progress the home had made in meeting the concerns we had raised at our previous inspections. During the inspection we spoke with relatives of people that lived at the home, care and nursing staff, the registered manager and the regional manager. We spent time observing people's care as people that lived at the home were not able to tell us of their experiences.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

Systems were in place to make sure that the premises were safe and secure. The required health and safety checks and servicing were completed.

The home had proper procedures in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. Staff were aware of their responsibilities to respect people's rights and to keep people safe.

The home had a risk management system in place and acted upon any incidents or accidents. It worked closely with other agencies to promote people's safety. We had concerns about the diversity of people's needs on one of the units and how the risks to people were managed. We have asked the provider to take action to address this.

Is the service effective?

People's health and care needs were assessed. People’s nutritional, personal care and mobility needs were identified in their plans of care. Monthly reviews of care were completed to make sure that care remained appropriate. Some people needed additional support to manage their behaviour. These plans would benefit from being more comprehensive and including the specific actions staff should take to respond to any incidents.

People that needed specialised diets were provided with them. People were supported to eat and drink. Gaps in some food and fluid charts meant that the amount of food and drink people consumed was not always accurately monitored.

Some signage was in place to help people to know their way around the home. The provider told us that other changes were planned to make the accommodation better for the people that lived there.

Is the service caring?

People were supported by staff that showed them respect and promoted their dignity. Most relatives were pleased with the care provided. One relative said: “I have peace of mind when I leave that they will be well looked after”.

Plans of care included some information about people’s previous lifestyle and individual needs.

Relatives involved with the service had the opportunity to complete an annual satisfaction survey. The home had relatives meetings and the manager took action to address any concerns.

Is the service responsive?

The service gave people the opportunity to take part in a number of activities. There continues to be scope for these to be further developed as we saw periods when people were sitting with little stimulation.

The service had a complaints procedure. This was made available to people. Few complaints had been received but we saw that when they were raised they were acted upon.

The service worked closely with health and social care staff to support people to manage their behaviour.

Is the service well led?

The service had a quality assurance system. A range of audits and checks were completed covering such areas as care planning and medication. Records we saw showed when shortfalls were identified they were acted upon. The service had a remedial action plan in place to improve the service to people.

11 December 2013

During an inspection looking at part of the service

We completed this inspection to check that the provider had made improvements to the care provided to people. When we visited in July 2013 the provider was not meeting a number of regulations. During the inspection we spent time talking with care staff, people that lived at the service and with relatives. Since we visited last time a new manager was in post. They were not yet registered with us.

People and relatives told us they were satisfied with their care. Some of our previous concerns had been addressed but improvements were still needed to make sure people received safe and appropriate care.

Staff had received training in identifying incidents of potential abuse and knew the actions to take if they had any concerns that abuse had occurred. The manager knew how to refer potential incidents for investigation.

The provider had improved the way that staff were recruited. All the required checks were completed.

We saw that care staff received the training and support to provide care to an acceptable standard. Over 90% of staff had completed training and all the care and nursing staff had met the manager to discuss their work.

Effective systems were in place to monitor and check the quality of care provided to people. Action plans were in place to address the shortfalls these checks identified.

Improvements had been made in the record keeping but further improvements were needed to make sure that the records provided up to date and accurate information.

1 July 2013

During a routine inspection

This was an unannounced scheduled inspection. The home did not know we were visiting. During the inspection we spoke with one person, staff, relatives, the recently appointed peripatetic manager and a regional manager. We spent time observing the care people received as most people were unable to speak with us.

Relatives we spoke with said they felt that the care had improved and they were happy with the care their relative received.

People's needs were assessed and plans of care were in place. People were supported to have their personal care needs met and access health care support. Records of care were not always properly completed to show that people received the care they needed.

People did not receive sufficient stimulation to promote their wellbeing. There were some activities available but some people sat for periods with nothing to do.

Care staff were not well supervised and trained. The home provided a range of training but a lot of staff were not up to date with their training. Supervision of care staff had recently been introduced.

The home sought the views of people and relatives that used the service. The home had a system in place to monitor and review the quality but this had not been consistently completed.

28 January 2013

During an inspection looking at part of the service

This inspection was undertaken to review actions taken since our previous inspection and assess the service's compliance with the regulations.

We spoke to three people who lived at the home and eight staff members. People we spoke with told us, "They are very good here you know", and "I do love the girls they are so good".

We saw that people were treated with respect and had their dignity promoted. People were given choices about their life in the home and their choices were respected.

We found that the home had made improvements which demonstrated that it was compliant with the regulation we assessed.

18 July 2012

During a routine inspection

We carried out this inspection as part of our planned programme of inspections. The visit was unannounced and neither the staff nor the provider knew that we would be visiting.

The inspection included the observation of care experienced by people living at the

home, talking to people who were living in the home, talking with the manager and staff on duty, looking in detail at all aspects of care for six people with complex needs, viewing people's rooms and discussing their care with staff. This process is known as pathway tracking.

Marquis Court (Windsor House) shares the site with its sister home Marquis Court (Tudor House) which is managed separately.

The home provided care and support for people who had dementia. We found that the home was arranged to accommodate people with mild dementia on the lower ground floor, people with moderate dementia on the middle floor and advanced dementia and behavioural difficulties on the top floor. The lower ground floor was in the process of being refurbishment to provide facilities for a re-enablement unit and will have its own kitchenette to enable people to make their own drinks and snacks and undertake some of their own laundry. It is anticipated that changes to this unit will be completed by the end of August 2012.

We met with the manager, area manager, six staff, four visitors to the service and six people who live at the home. People we spoke with were all positive about the care and support that they or their relative received. One person told us; "It's a good place to live", another said "Yes it's very nice here". One person living on the top floor told us, "Yes it's ok but it can be noisy". Two visitors told us that the care at Marquis Court (Windsor house) was much better than the home their relative had previously lived at. We were told, "They (the staff) seem to understand dementia and xx seems much happier here".

We found that people's bedrooms were spacious and had the specialist equipment that people needed to keep them safe and comfortable. People, frequently with the support of their families, had personalised their bedrooms as they chose to reflect their taste and interest.

We saw how people spent their day. People were generally given a choice of where they spent their time however there was not much for them to do. One person said, "I just watch television either in here or in my room". People who were able told us that they got up and went to bed when they wanted and that there was always a choice of what to eat and drink. There was a need for more things for people to do and especially activities that promoted people's memory. The appointment of a new activity coordinator and initiatives such as "The resident experience day", would develop positive dementia care for people living at Marquis Court (Windsor House).

We observed staff to be caring and patient despite outbursts of verbal aggression directed at them. We saw that generally staff provided people with the assistance they needed. Increased staffing levels and improved staff training for the management of dementia and challenging behaviour would assist this further.

We found that the service had responded positively to any concerns and had appropriate systems in place to protect people from harm.

The appointment of an experienced mental health nurse as a manager for Windsor House has had a positive impact on the support and management of staff and the care people receive.

8 March and 5 April 2011

During a routine inspection

There was evidence that people had been involved in the setting of assessed care plans, confirmed with a relative's comment: "When my mum was transferred we were asked a lot of questions regarding mum's needs, and we asked a few about the home, it proved to be a pleasant and helpful exchange', mum told us: 'The information I received was very informative and helpful'.

During the course of the inspection comments were received from several people using the service, and people visiting at the time. We asked for their comments on the quality of the service and care given. There was a clear appreciation of the openness and opportunity to contribute, and of the improvements in standards overall, "We have found Windsor House to be relaxed, friendly and have a homely atmosphere. It's good to be involved and kept up to date", "When the need arises the Doctor is always contacted if there is a problem, I've generally found them to very good at their job, and pleasant", "Things are much more confident now, last night we had a long conversation about dad's care. Happy with the staff and the home".

A monitoring officer from Social Services commented: "Those residents I saw this morning felt they were treated well. One resident stated that she could speak to staff at any time, if they were busy they would explain that and always return to her as soon as possible".

Information received from surveys conducted by the Provider indicates that the majority of people are happy with the nursing and medical care they received, they told us that they were treated with respect and that visitors were made to feel welcome. One person told us that the staff were, 'Golden, a grand set of girls' and had given her everything she needed. She said that the staff were respectful and maintained her privacy.

People interviewed confirmed that that the quantity and quality of food provided was generally good. Comments we received in the course of inspection: "It's comfortable, the meals are good, there's always something else if you don't want to eat it", and "Good variety of meals for residents, with menus on the dining tables". A relative told us 'It is good to see that mum's fluids are encouraged, that she gets the help she needs at meal times, and the quality of the food is satisfactory'.

Our observations showed that generally people using the service appeared to be content, comfortable and happy with their life style, complimentary regarding the quality of their lives and the care they receive at Marquis Court, "I have no complaints against my treatment here. I have the odd hiccough, but these are very small, and do not effect my view of the Home, it is clean, and staff give help when needed", "If I need to a doctor is always available on request, and if paramedics are needed, they get here straight away, and no time is wasted " and "The home is well organised now, and the staff are as good as gold", and "The staff are very kind".

The people spoken to generally remark that they find the environment always very clean and fresh. "I'm pleased, very much so, a very pleasant environment", "Cleaned every day, excellent", and "The home achieves a high standard of cleanliness".

We talked to a number of people who confirmed that they received their medication when they needed it, and did not have any concerns. They told us of a confident and open relationship with the nursing staff, who were generally able to explain and clarify medicine issues with people.

Several people spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Some comments we received from people spoken to on the day: "I've been here for three years and found everything to be satisfactory, although a little noisy at times", "Since our mum came in over a year ago, she has looked at Windsor House as her own home", "The staff keep the home nice and clean, and its nice to have my own bedroom".

Generally there was an overall satisfaction with the performance and relationships with staff at Windsor House. "They usually listen and try to meet our needs", "The staff make a big effort, they work hard and really care for us. There are times when I have to wait but overall they are really good", "The staff are lovely people, very kind and very helpful'.

From those staff we spoke with:' Since my time at Windsor House I have received a lot of support and guidance from the management and nursing staff. I worked under strict supervision until I felt fully competent to work alone", and "Training opportunities ensure nurses are up to date, and staffing levels are much improved".

We spoke with a number of people using the service and visitors, which demonstrated a readiness for people to express their views as to the quality of their care. The majority of comments were positive, although some were not so complimentary, although we could not concur with most, from our discussions and observations. Nevertheless we understand that active address is given, and action is taken relating to negative comments, if appropriate.

We asked people if they knew how to make a complaint, and if they felt the service was lacking in any way. There were a few minor concerns expressed, which generally focused on the lack of staff numbers, being bored at times with insufficient stimulus during the day. "I don't have any complaints, if I'm not happy, I know I can ask the manager of the home, or member of staff, they are very helpful", "When we have a worry about something our concerns have been responded to by the manager, that is, medication and eating issues", and "There have been a lot of changes, but all for the better. I have no complaints to date".